The Effect of Integrated Care Management on Dementia in Atrial Fibrillation

Abstract

Clinical outcomes of patients with atrial fibrillation (AF) can be improved by an integrated care approach. We analyzed whether adherence with the AF Better Care (ABC) pathway for integrated care management would reduce the risk of dementia in a nationwide AF cohort. Using the National Health Insurance Service database of Korea, 228,026 non-valvular AF patients were retrospectively evaluated between 2005 and 2015. Patients meeting all criteria of the ABC pathway were classified as the “ABC” group and those not classified as the “non-ABC” group. During a median (25th, 75th percentiles) follow-up of 6.0 (3.3, 9.5) years, the ABC group had lower rates and risk of overall dementia (0.17 vs. 1.11 per 100 person-years, p < 0.001; hazard ratio (HR) 0.80; 95% CI 0.73–0.87) and both Alzheimer’s (HR 0.79, 95% CI 0.71–0.88) and vascular dementia (HR 0.76, 95% CI 0.59–0.98) than the non-ABC group. The stratified analysis showed that the ABC pathway reduced the risk of dementia regardless of sex, comorbidities, and in patients with high stroke risk. Adherence with the ABC pathway is associated with a reduced risk of dementia in AF patients. Due to the high medical burden of AF, it is necessary to implement integrated AF management to reduce the risk of dementia.

Adherence to the ‘Atrial Fibrillation Better Care’ Pathway in Patients with Atrial Fibrillation: Impact on Clinical Outcomes—A Systematic Review and Meta-Analysis of 285,000 Patients

“…This evidence, together with other data generated by secondary analyses of the studies included in this systematic review, which showed a significant impact of the ABC-pathway-adherent care in reducing the risk of dementia 32 and a significant reduction in health-care-associated costs, 33 strongly supports the recent changes introduced in the 2020 ESC AF clinical guidelines. 12 In these guidelines, there is a paradigm shift in approach, placing the patient at the centre of the physicians' action, not the disease itself.…”

Integrated care and outcomes in patients with atrial fibrillation and comorbidities

“…1,6,7 Several post hoc analyses in various studies showed that the use of clinical care compliant to the ABC pathway criteria was associated with a reduction in risk of adverse outcomes. [8][9][10][11][12] In a recent cluster randomized trial, a mobile health-based ABC pathway management strategy significantly reduced the risk of the composite outcome of major clinical events. 13 Considering that AF patients with specific 'metabolic' comorbidities (i.e.…”

The Atrial Fibrillation Better Care pathway for managing atrial fibrillation: a review

“…Three datasets were prospectively collected, 12 , 15–18 two were retrospective post hoc analyses of prospectively collected data 19 , 21 , 22 and two were registries or electronic health records. 13 , 14 , 20 , 23 Characteristics of the included studies are provided in Table 1 . Studies used data from around the world: South Korea ( n = 3), 13 , 14 , 23 China ( n = 2), 17 , 18 the Middle East ( n = 2), 15 , 16 Italy ( n = 1), 19 Europe ( n = 1), 20 the USA and Canada ( n = 2), 21 , 22 and the Balkans ( n = 1).…”

“… 13 , 14 , 20 , 23 Characteristics of the included studies are provided in Table 1 . Studies used data from around the world: South Korea ( n = 3), 13 , 14 , 23 China ( n = 2), 17 , 18 the Middle East ( n = 2), 15 , 16 Italy ( n = 1), 19 Europe ( n = 1), 20 the USA and Canada ( n = 2), 21 , 22 and the Balkans ( n = 1). 12 …”